触诊

Palpation uses specific hand surfaces for different purposes. Finger pads, with dense sensory innervation, detect fine details like mass borders and lymph nodes. Fingertips examine structures like nailbeds and liver edges. The palmar surface surveys large body areas during abdominal palpation. The ulnar surface of the hand and fifth finger appreciates vibration during tactile fremitus assessment. The dorsal surface provides rough temperature comparison between body regions.

Proper hand preparation ensures patient safety and comfort during palpation. Clinicians must keep fingernails clean, groomed, and trimmed to prevent injury. Hands should be washed with soap and water or disinfected topically. Warming hands with warm water or friction reduces patient discomfort. Protective equipment like gloves should be worn when infection control precautions are needed, though barriers may affect rapport-building with patients.

When examining an area of discomfort, ask the patient to point out the exact location first. Palpate the tender area toward the end of the examination to minimize anxiety. Explain your intention clearly: 'I'm going to examine this area last in order just to make it more comfortable for you.' This approach demonstrates empathy, builds trust, and allows the patient to prepare mentally for potential discomfort during the examination.

Palpation pressure and duration must be adjusted based on the structure being examined. Insufficient pressure may prevent detection of deep structures, while excessive pressure can occlude pulses and cause discomfort. Duration is equally important; for example, adequate time is needed during lower extremity palpation to reveal pitting edema. Deliberate adjustment of these factors ensures accurate diagnostic information and patient comfort.

Touch during palpation communicates caring and comfort, shaping patient perceptions of healthcare providers positively. Physical contact from clinicians has been associated with decreased cortisol and increased serotonin levels in patients. Through careful use of palpation and touch, clinicians gain diagnostic information while developing rapport and promoting healing. This therapeutic aspect of touch is fundamental to comprehensive patient care during physical examination.

Begin by palpating the nailbeds with your fingertips to assess capillary refill and pallor, gauging patient comfort with touch. Then palpate the radial pulse using finger pads. After establishing rapport through these initial contacts, move to the anatomic region of interest, such as the abdomen. This sequence allows clinicians to assess patient comfort before proceeding to more sensitive examination areas.

Use draping techniques to balance patient modesty with examination access. Always ask permission before palpating and provide warnings if the procedure may worsen pain. Express empathy when examining sensitive areas. At the examination's end, drape the patient back and thank them for cooperation. These communication strategies, combined with proper adjustment of patient attire during the physical exam, demonstrate respect and build therapeutic relationships.